Pathology V

Question 1

What causes secondary hyperparathyroidism?

Answer 1

Secondary hyperplasia due to decreased gut calcium absorption and increased phosphate. Most often occurs in chronic renal disease (hypovitaminosis D which decreases calcium absorption) (p.300)

Question 2

What lab findings are consistent with a diagnosis of secondary hyperparathyroidism?

Answer 2

Hypocalcemia, hyperphosphatemia in chronic renal failure (hypophosphatemia in most other causes), increased alkaline phosphatase, increased PTH (p.300)

Question 3

What lab finding distinguishes primary hyperparathyroidism from secondary hyperparathyroidism?

Answer 3

Primary: hypercalcemia; secondary: hypocalcemia (p.300)

Question 4

What lab finding distinguishes secondary hyperparathyroidism due to chronic renal failure from secondary hyperparathyroidism due to other causes?

Answer 4

In chronic renal failure- hyperphosphatemia, in other causes- hypophosphatemia (p.300)

Question 5

What is renal osteodystrophy?

Answer 5

Bone lesions due to secondary or teritary hyperparathyroidism caused by renal disease (p.300)

Question 6

What causes tertiary hyperparathyroidism?

Answer 6

Refractory (autonomous) hyperparathyroidism due to chronic renal disease (p.300)

Question 7

What lab findings are consistent with a diagnosis of tertiary hyperparathyroidism?

Answer 7

Highly elevated PTH, elevated calcium (p.300)

Question 8

What are the three most common causes of hypoparathyroidism?

Answer 8

Accidental surgical excision, autoimmune destruction, DiGeorge syndrome (p.300)

Question 9

What findings are consistent with hypoparathyroidism?

Answer 9

Hypocalcemia, tetany (p.300)

Question 10

What is Chvostek’s sign?

Answer 10

Contraction of the facial muscles due to tapping of the facial nerve; caused by hypoparathyroidism and hypocalcemia (p.300)

Question 11

What is Trosseau’s sign?

Answer 11

Carpal spasm due to occlusion of the brachial artery with BP cuff; caused by hypoparathyroidism and hypocalcemia (p.300)

Question 12

In what conditions are Chvostek’s sign and Trosseau’s sign seen?

Answer 12

Hypoparathyroidism and hypocalcemia (p.300)

Question 13

What is pseudohypoparathyroidism?

Answer 13

A genetic condition causing kidney unresponsiveness to PTH (p.300)

Question 14

What is another name for pseudohypoparathyroidism?

Answer 14

Albright’s hereditary osteodystrophy (p.300)

Question 15

How is Albright’s hereditary osteodystrophy inherited?

Answer 15

Autosomal dominant inheritance (p.300)

Question 16

What findings are associated with pseudohypoparathyroidism (Albright’s herediary osteodystrophy)?

Answer 16

Hypocalcemia, shortened 4th/5th digits, short stature (p.300)

Question 17

Name two common causes of PTH independent hypercalcemia?

Answer 17

Excess calcium ingestion, cancer (p.300)

Question 18

What is the most common form of pituitary adenoma?

Answer 18

Prolactinoma (p.301)

Question 19

What are the clincial findings associated with pituitary adenoma?

Answer 19

In prolactinoma- amenorrhea, galactorrhea, low libido, infertility (p.301)

Question 20

What hormone is low in cases of pituitary adenoma?

Answer 20

Decreased GnRH (p.301)

Question 21

What types of visual changes may be seen in a patient with pituitary adenoma?

Answer 21

Bitemporal hemianopia due to impingement of optic chiasm (p.301)

Question 22

What is the pharmalogical treatment for pituitary adenoma (prolactinoma)?

Answer 22

Dopamine agonists- bromocriptine or cabergoline. This can cause shrinkage of prolactinomas (p.301)

Question 23

What causes acromeagly?

Answer 23

Excess GH in adults, usually caused by pituitary adenoma (p.301)

Question 24

What is the difference between excess GH in adults vs children?

Answer 24

In children, increased linear bone growth causes gigantism (p.301)

Question 25

What are the clinical findings in a patient with acromeagly?

Answer 25

Large tongue with deep furrows, deep voice, large hands and feet, coarse facial features, impaired glucose tolerance (insulin resistance) (p.301)

Question 26

What lab finding is consistent with a diagnosis of acromeagly?

Answer 26

Increased serum IGF-1 (p.301)